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Letters |15 June 1995

The Cushing Syndrome

David N. Orth

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892. Vanderbilt University Medical Center, Nashville, TN 37232-2250.
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IN RESPONSE:
Drs. Avgerinos and Cutler [1] fail to address a central issue [2]: The diagnosis of the Cushing syndrome and the differential diagnosis of its causes do not depend on a single diagnostic test result but rather on the consistency of multiple test results in indicating a single cause. Matrix analysis addresses the following type of question: What is the probability that an individual patient has ectopic as opposed to pituitary ACTH secretion if his or her basal urine free cortisol excretion is greater than w µgrams/24 h and decreases by less than x% after high-dose dexamethasone administration, his basal midnight plasma ACTH level is greater than y pg/mL, and his plasma 11-deoxycortisol level increases by less than z% after metyrapone administration? An individual patient might fail to meet the authors' criteria for 100% specificity for any one test, but the combination of less stringent criteria for multiple tests may have equal or greater diagnostic power.
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Orth DN. The Cushing Syndrome. Ann Intern Med. ;122:959–960. doi: 10.7326/0003-4819-122-12-199506150-00014

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Published: Ann Intern Med. 1995;122(12):959-960.

DOI: 10.7326/0003-4819-122-12-199506150-00014

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